Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Filters applied. Clear all
. 2015 Sep;28(9):1053-9.
doi: 10.1016/j.echo.2015.06.002. Epub 2015 Jul 10.

Focused Cardiac Ultrasound in Place of Repeat Echocardiography: Reliability and Cost Implications

Affiliations
Free PMC article

Focused Cardiac Ultrasound in Place of Repeat Echocardiography: Reliability and Cost Implications

Vinay Kini et al. J Am Soc Echocardiogr. .
Free PMC article

Abstract

Background: Health care systems are increasingly moving toward models that emphasize the delivery of high-quality health care at lower costs. Rates of repeat echocardiography (two or more transthoracic echocardiographic studies performed within a short interval) are high and can contribute substantially to the cost of providing cardiovascular care. Certain findings from handheld ultrasound scans performed by echocardiographers have been shown to correlate well with findings on transthoracic echocardiography (TTE). It therefore may be feasible and cost effective to use expert focused cardiac ultrasound (eFCU) in place of repeat TTE for highly selected indications in certain settings. The aim of this study was to determine the reliability and cost implications of using eFCU in place of repeat TTE in selected inpatients.

Methods: Inpatients who underwent repeat TTE (prior TTE within 30 days) ordered for the assessment of ventricular function, pericardial effusion, or inferior vena cava collapse were prospectively enrolled. Subjects underwent eFCU in addition to TTE, and results were compared for correlation using the weighted κ statistic. The potential cost savings of using eFCU in place of TTE were modeled from the provider perspective (i.e., physicians and hospitals).

Results: Over 45 days, 105 patients were enrolled. The majority of scans were performed for assessment of left ventricular function and pericardial effusions. eFCU showed excellent correlation with TTE for most parameters, including left ventricular systolic function (κ = 0.80) and the presence and size of pericardial effusions (κ = 0.81) (P < .001 for both). Adoption of this eFCU protocol could save between $41 and $64 per study, or between $34,512 and $53,871 annually at the authors' institution.

Conclusions: Findings from eFCU correlate well with those from TTE when used in the setting of repeat testing for assessment of ventricular function, pericardial effusion, and inferior vena cava collapse. The judicious use of eFCU in place of repeat inpatient TTE has the potential to deliver quality cardiac imaging at reduced cost.

Keywords: Cost-effectiveness; Echocardiography; Focused cardiac ultrasound.

Figures

Figure 1
Figure 1
Example images from eFCU (left) and TTE (right). (A) A patient status post atrial fibrillation ablation to rule out peri-cardial effusion, (B) a patient with metastatic cancer and a trace pericardial effusion, (C) a patient status post cardiac transplantation for follow-up of RV size and function, and (D) a patient with ischemic cardiomyopathy for follow-up of LV systolic function.
Figure 2
Figure 2
Correlation of eFCU and TTE for the assessment of LVEF. eFCU and TTE showed excellent correlation for LVEF using the Spearman correlation coefficient (r = 0.96, P < .001), indicating the potential feasibility of replacing TTE with eFCU for assessment of LVEF in certain patients.
Figure 3
Figure 3
Bland-Altman plot of the assessment of LVEF. Compared with TTE, the assessment of LVEF by eFCU showed only a small positive bias (bias = 1.3%; 95% CI, −8.1% to 10.7%), with a normal distribution, indicating good agreement between the two tests for assessment of LVEF per the study protocol.
Figure 4
Figure 4
Per-study cost difference between eFCU and TTE. Cost analysis showed that the labor cost of performing TTE was $73.16, compared with $32.05 for eFCU in a wage-based model and $8.99 for eFCU in an RVU-based model.

Comment in

Similar articles

See all similar articles

Cited by 4 articles

MeSH terms

Feedback